Basic Information
| Provider Information | |||||||||
| NPI: | 1669566212 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARRAGA | ||||||||
| FirstName: | JOHN PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 W. MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193381939 | ||||||||
| FaxNumber: | 9193382729 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W. MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CARRBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193381939 | ||||||||
| FaxNumber: | 9193382729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 5434 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 144PG | 01 | NC | BCBS | OTHER | 6103568 | 05 | NC | MEDICAID |